1
|
Kellner E, Sekula P, Reisert M, Köttgen A, Lipovsek J, Russe M, Horbach H, Schlett CL, Nauck M, Völzke H, Kröncke T, Bette S, Kauczor HU, Keil T, Pischon T, Heid IM, Peters A, Niendorf T, Lieb W, Bamberg F, Büchert M, Reichardt W. Imaging Markers Derived From MRI-Based Automated Kidney Segmentation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:284-290. [PMID: 38530931 PMCID: PMC11381199 DOI: 10.3238/arztebl.m2024.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Population-wide research on potential new imaging biomarkers of the kidney depends on accurate automated segmentation of the kidney and its compartments (cortex, medulla, and sinus). METHODS We developed a robust deep-learning framework for kidney (sub-)segmentation based on a hierarchical, three-dimensional convolutional neural network (CNN) that was optimized for multiscale problems of combined localization and segmentation. We applied the CNN to abdominal magnetic resonance images from the population-based German National Cohort (NAKO) study. RESULTS There was good to excellent agreement between the model predictions and manual segmentations. The median values for the body-surface normalized total kidney, cortex, medulla, and sinus volumes of 9934 persons were 158, 115, 43, and 24 mL/m2. Distributions of these markers are provided both for the overall study population and for a subgroup of persons without kidney disease or any associated conditions. Multivariable adjusted regression analyses revealed that diabetes, male sex, and a higher estimated glomerular filtration rate (eGFR) are important predictors of higher total and cortical volumes. Each increase of eGFR by one unit (i.e., 1 mL/min per 1.73 m2 body surface area) was associated with a 0.98 mL/m2 increase in total kidney volume, and this association was significant. Volumes were lower in persons with eGFR-defined chronic kidney disease. CONCLUSION The extraction of image-based biomarkers through CNN-based renal sub-segmentation using data from a population-based study yields reliable results, forming a solid foundation for future investigations.
Collapse
Affiliation(s)
- Elias Kellner
- Division of Medical Physics, Department of Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peggy Sekula
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Division of Medical Physics, Department of Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Jan Lipovsek
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Maximilian Russe
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Harald Horbach
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Germany
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Thomas Kröncke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Germany
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Germany
| | - Stefanie Bette
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostical and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Institute of Clinical Epidemiology and Biometry, University of Würzburg, State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group; Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Iris M. Heid
- Chair of Genetic Epidemiology, University of Regensburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg; Chair of Epidemiology, Institute for Medical Information Processing, Biometrics, and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich; DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich; DZD (German Centre for Diabetes Research), Neuherberg
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Martin Büchert
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Core Facility MRDAC, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Wilfried Reichardt
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
2
|
Lan KC, Peng PJ, Chang TY, Liu SH. Resveratrol Alleviates Advanced Glycation End-Products-Related Renal Dysfunction in D-Galactose-Induced Aging Mice. Metabolites 2023; 13:metabo13050655. [PMID: 37233696 DOI: 10.3390/metabo13050655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
The elderly have higher concentrations of advanced glycation end-products (AGEs). AGEs are considered risk factors that accelerate aging and cause diabetic nephropathy. The effects of AGEs on renal function in the elderly remain to be clarified. This study aimed to explore the role of AGEs in renal function decline in the elderly and the protective effect of resveratrol, a stilbenoid polyphenol, comparing it with aminoguanidine (an AGEs inhibitor). A D-galactose-induced aging mouse model was used to explore the role of AGEs in the process of renal aging. The mice were administered D-galactose subcutaneously for eight weeks in the presence or absence of orally administered aminoguanidine or resveratrol. The results showed that the serum levels of AGEs and renal function markers BUN, creatinine, and cystatin C in the mice significantly increased after the administration of D-galactose, and this outcome could be significantly reversed by treatment with aminoguanidine or resveratrol. The protein expression levels for apoptosis, fibrosis, and aging-related indicators in the kidneys were significantly increased, which could also be reversed by treatment with aminoguanidine or resveratrol. These findings suggest that resveratrol could alleviate AGEs-related renal dysfunction through the improvement of renal cellular senescence, apoptosis, and fibrosis in D-galactose-induced aging in mice.
Collapse
Affiliation(s)
- Kuo-Cheng Lan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Pei-Jin Peng
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 100233, Taiwan
| | - Ting-Yu Chang
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 100233, Taiwan
| | - Shing-Hwa Liu
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei 100233, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
- Department of Pediatrics, College of Medicine, National Taiwan University & Hospital, Taipei 100233, Taiwan
| |
Collapse
|
3
|
Maintenance of Skeletal Muscle to Counteract Sarcopenia in Patients with Advanced Chronic Kidney Disease and Especially Those Undergoing Hemodialysis. Nutrients 2021; 13:nu13051538. [PMID: 34063269 PMCID: PMC8147474 DOI: 10.3390/nu13051538] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/18/2022] Open
Abstract
Life extension in modern society has introduced new concepts regarding such disorders as frailty and sarcopenia, which has been recognized in various studies. At the same time, cutting-edge technology methods, e.g., renal replacement therapy for conditions such as hemodialysis (HD), have made it possible to protect patients from advanced lethal chronic kidney disease (CKD). Loss of muscle and fat mass, termed protein energy wasting (PEW), has been recognized as prognostic factor and, along with the increasing rate of HD introduction in elderly individuals in Japan, appropriate countermeasures are necessary. Although their origins differ, frailty, sarcopenia, and PEW share common components, among which skeletal muscle plays a central role in their etiologies. The nearest concept may be sarcopenia, for which diagnosis techniques have recently been reported. The focus of this review is on maintenance of skeletal muscle against aging and CKD/HD, based on muscle physiology and pathology. Clinically relevant and topical factors related to muscle wasting including sarcopenia, such as vitamin D, myostatin, insulin (related to diabetes), insulin-like growth factor I, mitochondria, and physical inactivity, are discussed. Findings presented thus far indicate that in addition to modulation of the aforementioned factors, exercise combined with nutritional supplementation may be a useful approach to overcome muscle wasting and sarcopenia in elderly patients undergoing HD treatments.
Collapse
|
4
|
Pai MP, Debacker KC, Derstine B, Sullivan J, Su GL, Wang SC. Comparison of Body Size, Morphomics, and Kidney Function as Covariates of High‐Dose Methotrexate Clearance in Obese Adults with Primary Central Nervous System Lymphoma. Pharmacotherapy 2020; 40:308-319. [DOI: 10.1002/phar.2379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manjunath P. Pai
- Department of Clinical Pharmacy College of Pharmacy University of Michigan Ann Arbor Michigan
| | - Kenneth C. Debacker
- Department of Clinical Pharmacy College of Pharmacy University of Michigan Ann Arbor Michigan
| | - Brian Derstine
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor Michigan
| | - June Sullivan
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor Michigan
| | - Grace L. Su
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor Michigan
- Department of Medicine VA Ann Arbor Health System Ann Arbor Michigan
| | - Stewart C. Wang
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor Michigan
| |
Collapse
|
5
|
Predictive Value of Cortical Thickness Measured by Ultrasonography for Renal Impairment: A Longitudinal Study in Chronic Kidney Disease. J Clin Med 2018; 7:jcm7120527. [PMID: 30544567 PMCID: PMC6306756 DOI: 10.3390/jcm7120527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Kidney size is associated with renal function, however it is not elucidated whether kidney size is a risk for the progression of chronic kidney disease. The aim of this study was to investigate the predictive value of morphological evaluation of kidney size by ultrasonography for the progression of renal dysfunction. Methods: Morphological parameters including kidney length, volume, cortical thickness, and medullary thickness were measured by ultrasonography in 87 patients with chronic kidney disease, and adjusted by body size. Renal functions at baseline and after 2 years were measured and the associations of morphological parameters to decline in renal function over 2 years were analyzed. Results: Height-adjusted cortical thickness was correlated to decline in renal function (r = 0.426, p < 0.001). Height-adjusted cortical thickness could predict renal dysfunction with the area under the curve of 0.786, and height-adjusted cortical thickness of 4.0 mm/cm was a cut off value with a sensitivity of 72.5% and a specificity of 80.0% for the risk of a more than 30% decline in renal function or initiation of dialysis. Conclusions: We provide new insights into the utility of measuring cortical thickness by ultrasonography for predict future renal impairment.
Collapse
|
6
|
Dekkers IA, Paiman EHM, de Vries APJ, Lamb HJ. Reproducibility of native T 1 mapping for renal tissue characterization at 3T. J Magn Reson Imaging 2018; 49:588-596. [PMID: 30171825 PMCID: PMC6585932 DOI: 10.1002/jmri.26207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
Background Advanced renal disease is characterized by adverse changes in renal structure; however, noninvasive techniques to diagnose and monitor these changes are currently lacking. Purpose To evaluate the reproducibility of native T1 mapping for renal tissue characterization. Study Type Reproducibility study. Population Fifteen healthy volunteers (mean age 31 years, range 19–63 years), and 11 patients with diabetic nephropathy (mean age 57 years, range 51–69 years). Field Strength/Sequence 3T, modified Look–Locker imaging (MOLLI) 5(3)3. Assessment Intra‐ and interexamination reproducibility of voxel‐based T1 relaxation times of renal cortex and medulla was assessed in healthy human volunteers and diabetic nephropathy patients. Statistical Tests Reproducibility was evaluated using Bland–Altman and intraclass correlation coefficients (ICCs). Results Intra‐ and interexamination reproducibility of renal native T1 mapping showed good–strong ICCs (0.83–0.89) for renal cortex and medulla, and moderate–good ICCs (0.62–0.81) for cortex–medulla ratio in both healthy volunteers and diabetic nephropathy patients. Intra‐ and interexamination limits of agreement were respectively (–124 msec, + 82 msec) and (–134 msec, + 98 msec) for renal cortex and (–138 msec, + 107 msec) and (–118 msec, + 151 msec) for medulla. Overall T1 values for renal cortex (P = 0.277) and medulla (P = 0.973) were not significantly different between healthy volunteers and diabetic nephropathy patients, in contrast to the cortex–medulla ratio (P = 0.003). Data Conclusion Renal native T1 mapping is a technique with good–strong intra‐ and examination reproducibility in both healthy volunteers and diabetic nephropathy patients. Level of Evidence: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:588–596.
Collapse
Affiliation(s)
- Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center and Leiden University, Leiden, the Netherlands
| | - Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center and Leiden University, Leiden, the Netherlands
| | - Aiko P J de Vries
- Division of Nephrology, Department of Medicine, Leiden University Medical Center and Leiden University, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center and Leiden University, Leiden, the Netherlands
| |
Collapse
|
7
|
Nakazato T, Ikehira H, Imasawa T. An equation to estimate the renal cortex volume in chronic kidney disease patients. Clin Exp Nephrol 2017; 22:603-612. [PMID: 29071505 DOI: 10.1007/s10157-017-1492-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The renal cortex volume is associated with the kidney function and chronic kidney disease (CKD) risk factors, and it may also be a prognostic factor. We aimed to create an equation to estimate the renal cortex volume of CKD patients in day-to-day clinical practice. METHODS The subjects included 116 ethnic Japanese CKD patients who were ≥ 18 years of age. The renal size (length, width and thickness) was measured by ultrasound. The body height, weight, year of age, sex, birth weight, gestational age, diabetes status, hypertension status, family history of CKD and dialysis and estimated glomerular filtration rate (eGFR) were collected as expected dependent variables. We made models for the equation regarding the renal cortex volume measured by non-contrast magnetic resonance imaging as a true renal cortex volume. Stepwise multiple linear regression analyses were performed with the log-transformation of dependent and independent variables. The accuracy of the models was compared using the leave one out cross-validation method. RESULTS The estimated volume of the renal cortex (cm3) = 0.012 × renal length (cm)0.92 × width (cm)0.53 × body weight (kg)0.40 × body height (cm)0.67 × eGFR (ml/min/1.73 m2)0.22 × 1.12 if diabetes. The adjusted R 2 value and the accuracy within 30 and 50% were 0.73, 0.94 and 0.99, respectively. CONCLUSIONS This study provided a new method for estimating the renal cortex volume in day-to-day clinical practice.
Collapse
Affiliation(s)
- Takashi Nakazato
- Department of Medical Information Management, National Hospital Organization Chiba Medical Center, 4-1-2 Tsubakimori Chuouku, Chiba, 260-8606, Japan.
| | - Hiroo Ikehira
- Department of Radiology, National Hospital Organization Chiba East Hospital, 673 Nitona Chuouku, Chiba, 260-8712, Japan
| | - Toshiyuki Imasawa
- Department of Internal Medicine, National Hospital Organization Chiba East Hospital, 673 Nitona Chuouku, Chiba, 260-8712, Japan
| |
Collapse
|
8
|
Denic A, Glassock RJ, Rule AD. Structural and Functional Changes With the Aging Kidney. Adv Chronic Kidney Dis 2016. [PMID: 26709059 DOI: 10.1053/h.ackd.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Senescence or normal physiologic aging portrays the expected age-related changes in the kidney as compared to a disease that occurs in some but not all individuals. The microanatomical structural changes of the kidney with older age include a decreased number of functional glomeruli from an increased prevalence of nephrosclerosis (arteriosclerosis, glomerulosclerosis, and tubular atrophy with interstitial fibrosis), and to some extent, compensatory hypertrophy of remaining nephrons. Among the macroanatomical structural changes, older age associates with smaller cortical volume, larger medullary volume until middle age, and larger and more numerous kidney cysts. Among carefully screened healthy kidney donors, glomerular filtration rate (GFR) declines at a rate of 6.3 mL/min/1.73 m(2) per decade. There is reason to be concerned that the elderly are being misdiagnosed with CKD. Besides this expected kidney function decline, the lowest risk of mortality is at a GFR of ≥75 mL/min/1.73 m(2) for age <55 years but at a lower GFR of 45 to 104 mL/min/1.73 m(2) for age ≥65 years. Changes with normal aging are still of clinical significance. The elderly have less kidney functional reserve when they do actually develop CKD, and they are at higher risk for acute kidney injury.
Collapse
Affiliation(s)
- Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA; and Division of Nephrology and Hypertension, Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - Richard J Glassock
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA; and Division of Nephrology and Hypertension, Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA; and Division of Nephrology and Hypertension, Division of Epidemiology, Mayo Clinic, Rochester, MN.
| |
Collapse
|
9
|
Determinants of renal shape in chronic kidney disease patients. Clin Exp Nephrol 2016; 20:748-756. [DOI: 10.1007/s10157-015-1220-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022]
|
10
|
Denic A, Glassock RJ, Rule AD. Structural and Functional Changes With the Aging Kidney. Adv Chronic Kidney Dis 2016; 23:19-28. [PMID: 26709059 DOI: 10.1053/j.ackd.2015.08.004] [Citation(s) in RCA: 438] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 07/07/2015] [Accepted: 08/19/2015] [Indexed: 01/08/2023]
Abstract
Senescence or normal physiologic aging portrays the expected age-related changes in the kidney as compared to a disease that occurs in some but not all individuals. The microanatomical structural changes of the kidney with older age include a decreased number of functional glomeruli from an increased prevalence of nephrosclerosis (arteriosclerosis, glomerulosclerosis, and tubular atrophy with interstitial fibrosis), and to some extent, compensatory hypertrophy of remaining nephrons. Among the macroanatomical structural changes, older age associates with smaller cortical volume, larger medullary volume until middle age, and larger and more numerous kidney cysts. Among carefully screened healthy kidney donors, glomerular filtration rate (GFR) declines at a rate of 6.3 mL/min/1.73 m(2) per decade. There is reason to be concerned that the elderly are being misdiagnosed with CKD. Besides this expected kidney function decline, the lowest risk of mortality is at a GFR of ≥75 mL/min/1.73 m(2) for age <55 years but at a lower GFR of 45 to 104 mL/min/1.73 m(2) for age ≥65 years. Changes with normal aging are still of clinical significance. The elderly have less kidney functional reserve when they do actually develop CKD, and they are at higher risk for acute kidney injury.
Collapse
|
11
|
Takata T, Koda M, Sugihara T, Sugihara S, Okamoto T, Miyoshi K, Hodotsuka M, Fujise Y, Matono T, Okano J, Hosho K, Iyama T, Fukui T, Fukuda S, Munemura C, Isomoto H. Left Renal Cortical Thickness Measured by Ultrasound Can Predict Early Progression of Chronic Kidney Disease. Nephron Clin Pract 2015; 132:25-32. [PMID: 26581096 DOI: 10.1159/000441957] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/24/2015] [Indexed: 11/19/2022] Open
Abstract
AIMS The kidney becomes atrophic in advanced chronic kidney disease, and renal size and parenchymal volume correlate with renal function. However, alterations in renal parenchymal volume have not been adequately studied in terms of the renal cortex and medulla. We investigated the relationship between the changes in the renal cortex and medulla and renal function. METHODS Renal ultrasound (US) parameters including renal length, parenchymal thickness, cortical thickness and medullary thickness were assessed in 176 subjects, who were categorized into 4 groups based on the estimated glomerular filtration rate (ml/min/1.73 m2): group 1, ≥ 90; group 2, ≥ 60 but < 90; group 3, ≥ 30 but < 60; and group 4, < 30. Renal US parameters in both kidneys were compared among the 4 groups. RESULTS We found stepwise associations in renal length, cortical thickness and parenchymal thickness with decreased renal function. Medullary thickness showed no changes among groups 1-3. Multiple linear regression analysis including sex, age and renal US parameters showed that only renal length was an independent predictor of renal function. When analyzed in groups 1-3, cortical thickness was the strongest associated parameter. Lower cortical left/right ratio (left cortical thickness/right cortical thickness) showed a stepwise association with a decrease in renal function. CONCLUSION Renal length and cortical thickness measured by US were correlated with renal function. In particular, left cortical thickness could help to detect early changes in renal function.
Collapse
Affiliation(s)
- Tomoaki Takata
- Division of Medicine and Clinical Science, Tottori University Faculty of Medicine, Tottori, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Chevalier RL. Congenital urinary tract obstruction: the long view. Adv Chronic Kidney Dis 2015; 22:312-9. [PMID: 26088076 PMCID: PMC4475271 DOI: 10.1053/j.ackd.2015.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/09/2015] [Accepted: 01/18/2015] [Indexed: 11/11/2022]
Abstract
Maldevelopment of the collecting system resulting in urinary tract obstruction (UTO) is the leading identifiable cause of CKD in children. Specific etiologies are unknown; most cases are suspected by discovering hydronephrosis on prenatal ultrasonography. Congenital UTO can reduce nephron number and cause bladder dysfunction, which contribute to ongoing injury. Severe UTO can impair kidney growth in utero, and animal models of unilateral ureteral obstruction show that ischemia and oxidative stress cause proximal tubular cell death, with later development of interstitial fibrosis. Congenital obstructive nephropathy, therefore, results from combined developmental and obstructive kidney injury. Because of inadequacy of available biomarkers, criteria for surgical correction of upper tract obstruction are poorly established. Lower tract obstruction requires fetal or immediate postnatal intervention, and the rate of progression of CKD is highly variable. New biomarkers based on proteomics and determination of glomerular number by magnetic resonance imaging should improve future care. Angiotensin inhibitors have not been effective in slowing progression, although avoidance of nephrotoxins and timely treatment of hypertension are important. Because congenital UTO begins in fetal life, smooth transfer of care from perinatologist to pediatric and adult urology and nephrology teams should optimize quality of life and ultimate outcomes for these patients.
Collapse
|